Provider Demographics
NPI:1861487423
Name:JONES, ANDREA D (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 W 79TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1554
Mailing Address - Country:US
Mailing Address - Phone:708-499-4100
Mailing Address - Fax:708-229-6078
Practice Address - Street 1:4901 W 79TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-499-4100
Practice Address - Fax:708-229-6078
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-107769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L95844Medicare ID - Type Unspecified
H76910Medicare UPIN
IL729903016Medicare PIN